feeding baby

Bringing up baby Your Health DR GITA MATHAI Every week I receive a ton of letters from anxious parents: is my baby’s weight ideal, is my child growing properly, is my parenting faulty? This week I’ll attempt to answer the most common questions. The birth weight of normal Indian children is on average 3-3.4kg. It depends on the health of the mother, with relatively bigger babies born to diabetic or pre-diabetic mothers, and smaller babies to mothers with hypertension. Preterm babies and twins also tend to weigh less at birth. The birth weight should ideally double at the end of the fifth month and triple at the end of the first year. This means that a child who weighed 2.5kg at birth will be around 7.5kg at the end of the first year. He or she will appear diminutive next to a child who was 3.5kg at birth and is therefore 10.5kg on the first birthday. Trying to force feed a child to gain more than expected is counterproductive. They may just regurgitate the extra food or develop an aversion to eating. There is no point in feeling guilty that you are a “bad mother” if your child is not the same size as your friends’ child. For the first 120 days, the child should preferably be exclusively breast fed. After that, weaning on to semisolid food should be started. Home cooked cereals are best. Although packaged ready-to-use cereals may appear attractive and time saving, they may contain preservatives, flavouring or excessive sodium. These are not advisable or healthy. One new home-cooked food, such as pureed vegetables or fruits, should be introduced every two weeks. Biscuits are not healthy or advisable. Patience and persistence is the key to successful weaning. The child should be eating a normal adult diet at the end of the first year. About 400-500ml of undiluted milk is all that is required after that age in a day. Teach your child to drink it without additives like tea, coffee or other “healthy” drinks. Unfortunately, demand for a “tonic” to make the child grow fatter or improve the appetite may result in steroid or cyproheptadine drops being administered. These chemicals do increase the appetite, but at a tremendous cost to the health of the child. Steroid drops increase the weight of the child owing to fluid retention. The face may become moon shaped and hairy. They suppress the immune system, so the child may get frequent infections, which may then escalate and become life threatening. Children need five meals a day — breakfast, a snack at 10-11am, lunch, a snack on returning from school, and dinner. Do not send them to tuitions hungry or to school without breakfast. Do not withhold food as punishment. (A snack does not mean packaged chips and biscuits). The ideal weight from the ages of 2-20 years can be measured with the BMI. This is the weight divided by the height in metre squared. The normal is between 18-23. Ideally, in children, the BMI can be read off charts available in most immunisation booklets. A healthy child should be between the fifth and 95th percentiles. Once the child becomes 5ft in height, the formula for ideal body weight (IBW) in males: 50kg + 2.3kg for each inch over 5ft. For females, IBW = 45.5kg + 2.3kg for each inch over 5 feet. India has progressed from being a country with malnourished children to one where the majority is overweight or frankly obese. If your child falls into that category restricting food or dieting is not an answer. Instead, healthy eating should be incorporated for the whole family, with 4-6 helpings of fruits and vegetables a day, no fried or ready to eat snacks, restricted sweets and deserts and NO aerated cola or flavoured drinks. This has to be combined with exercise. Physical activity is required from birth itself. Even before a baby crawls it should passively grasp, push and pull. Once a child begins to walk it should be active for at least three hours a day. This should be spread out with skipping, jumping hide and seek, playing ball and running. Just seating them in front of the TV (even if they would like to) is not a solution, nor is it helpful. School age children need to be physically active for an hour a day. This can include structured activity like coaching in a specific sport, cycling or running. This time spend makes them physically and mentally stronger. They are able to concentrate, work past fatigue and develop a sense of self worth. Habits like healthy eating and exercise inculcated in childhood remain throughout life. This definitely reduces the incidence of chronic diseases as they grow older. Also, in the process of rearing healthy children, you may change your diet and exercise habits, and become fit too! Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in

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illness explained

Why you fall ill

YOUR HEALTH / DR GITA MATHAI

An illness is always unwelcome but before knowing how to keep it away, we have to know what causes it. Ancient people believed that diseases were due to an imbalance between “heat” and “cold,” or because of possession by “spirits”. Today we know that diseases are caused by infectious agents (bacteria, viruses, intermediate organisms), genetic make up, nutritional excess or deficiency, immunological status, metabolic causes and faults at the cellular level. Almost all diseases fall into these basic groups, with some overlap, irrespective of the organ system where symptoms first manifest themselves. The body’s reaction to these external and internal forces determines the intensity and the duration of the disease. The body may be defective from birth, so much so that it may be incompatible with survival. Such a child may die in utero, soon after birth or in early childhood. Severe heart, kidney, liver and nervous system defects and multiple congenital abnormalities fall in this category. Today, many defects can be surgically or medically tackled, resulting in a normal lifespan. Many infectious diseases can now be cured with appropriate antibiotic, antiviral and anti-parasitic agents. However, overuse, self-medication and misuse of drugs has resulted in the emergence of some “super strains” of bacteria that may be lethal. Many infectious diseases can be prevented by immunisations started in childhood and continued in adult life. Examples are diphtheria, whooping cough, tetanus, small pox, polio, typhoid, chicken pox, jaundice (owing to Hepatitis A and B) H infuenzae (ear infection, meningitis), meningococcal meningitis, Pneumococcus (ear infections, pneumonia, meningitis), measles, German measles, mumps, HPV (which is responsible for some cancers), seasonal flu and Herpes Zoster. Unfortunately, 60-70 per cent of Indian children are incompletely immunised. Either the schedule itself is not finished or the boosters are not given. Sometimes vaccines that have to be given when the child is older are missed altogether. The elderly seldom take the immunisations they require. Diseases occur when the body’s cells refuse to obey centralised commands. They are suppose to regenerate and die in sequence, but if the balance is not perfect, diseases occur. When the regeneration slows down, hair falls out, bones become weak and memory suffers, among other things. If proliferation overtakes degeneration, cancers occur. The metabolic functions of the body are controlled by endocrine glands and enzyme reactions. These can fail or malfunction for genetic reasons, infections or age. This results in a gamut of diseases such as diabetes, hypertension and thyroid problems. In some people the body fails to recognise its own cells. It perceives some cells as alien and attacks them with a vengeance, destroying them and setting off cascading reactions with deleterious effects all over the body. This produces the spectrum of auto immune diseases such as rheumatoid arthritis and system lupus erythymatosis (SLE) and can lead to the destruction of bones, joints and many organ systems. Irrespective of the disease, patients want an immediate cure. In the case of an acute infectious disease, with proper diagnosis and adequate treatment a total cure is possible. But this takes time. Impatient and frustrated, patients may “doctor shop.” This can result in frequent changes in the antibiotic used or the addition of disease modifying steroids to rapidly eliminate symptoms. This does more harm than good. Meanwhile, many acute diseases “run their course” and are cured anyway. Chronic diseases such as arthritis, diabetes, COPD (asthma), seizures or cancer are often frustrating. There seems to be no cure in sight, and a lifetime of medication appears depressing. People are often tempted to try out other systems of medicine or natural cures. These, anecdotally or through advertisements, appear to have fewer side effects and offer a cure. Often, the basic defect is still present and the medication just has a placebo effect. When receiving treatment, do not mix up systems of medicine. Allopathic medicine encourages an evidence and diagnosis-based approach. Many other systems have a symptom-based approach to diagnosis and treatment, even though the same symptom (like jaundice) can appear in many disease processes. The medication taken under various systems can produce drug interactions. These may be difficult to diagnose and tackle. Our body needs to be nurtured from birth. We should restrict the number of chemicals we consume. This means avoiding processed infant foods, snacks with trans fats, coloured and caffeinated beverages, alcohol and nicotine in tobacco products. Genetics and the environment may make our bodies prone to certain diseases but with a healthy diet, an hour of exercise a day and adequate sleep, we can often offset these deleterious effects. Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in